THE CONTEXT OF HOME BASED CARE FOR HIV-AIDS PATIENTS

IN AN INFORMAL SETTLEMENT

Jennety Situnda & Reuben Sirinji

Rundu College of Education, Namibia.
March 2010

Abstract
What is the nature of the homestead environment on which the home-based care for
HIV-Aids patients depends in an urban informal residential area? Typically the
homesteads are inhabited by relatively long-term poor residents dominated by
females living in rather well swept but largely poor and overcrowded homes. They
earn a living from a miscellaneous range of informal sources, and could improve
their lives if assisted. A mixed range of social services have been proposed to help
alleviate the lives of the residents. The report provides a helpful understanding of
many factors that affect the quality of life and caring of patients at home.

Introduction
This report outlines the findings of the HIV-AIDS Club at Rundu College of Education,
in the Kavango region of Namibia. In an effort to understand how the Community
next to the College could cope with the caring of patients at home the Club undertook a
one day survey of the Kehemu informal settlement pf Rundu Town. The survey
investigated the quality of life as reflected by the numbers, gender, ages, and sources of
incomes of the residents in October 2008. Homesteads were assessed in terms
cleanliness and quality of buildings. Useful trends were identified towards suggesting
appropriate social service interventions that can help the quality of life and hence
capacity to care for HIV patients at home.

Administration of the Survey

A total of 19 respondents were interviewed in the Kehemu Settlement of Rundu Town
adjacent to the Rundu College of Education. The interviews were conducted on 11th
October 2008 by four male third year student volunteers active in the HIV-AIDs Club
at the College. Each of three students interviewed four people and the fourth student
interviewed three respondents.

The interviews were prompted by the need for the HIV-AIDS Committee at RCE to
collaborate with students in promoting Home-Based Care initiatives in the nearby
community. As such the interviews were a departure by the Committee from the talk
and information sharing norm towards actions that may proactively assist the
community. The HIV-Aids Committee designed the questionnaire instrument of ten
questions to guide the semi-structured collection of data by students from members of
the community. Eight questions were structured while two were open questions.
Students administered the questions by reading the questions to respondents then
scoring the responses, and writing down the open responses given by the interviewees.

Rationale of survey sample

Interviewed persons are not necessarily HIV-AIDS positive. They are simply residents
of Kehemu. However the general premise that everyone is infected or affected
qualifies them to address issues related to HIV-AIDS in their community. The nature
of their homestead environments is considered crucial to Home Based Care process. It
was assumed that the nature of the homestead environments can adequately be
described by residents of those homes responding to interview questions posed to
them. To increase the spread of people interviewed in Kehemu the interviewers
1
jumped at least two homes before selecting the next respondent.

Limitations of the Study

The interviews were conducted by RCE students whose research abilities may be
limited. The interviews were also all conducted on one day namely the 11th October
2008. All the four interviewers were male students, and their gender bias may not be
ruled out. The information collected from respondents depended on the abilities of
interviewers to correctly listen to what respondents say and accurately record it on
paper. Possible transcribing errors cannot therefore certainly be ruled out. The data
refers to the October 2008 Kehemu Informal settlement of Rundu in the Kavango
Region of Namibia. The extrapolative application of the findings to other times and
places should be cautious.

Strengths of the Study

The strengths of this survey could include that the data, views, and information
gathered were voluntarily and directly provided by the residents of the Kehemu
Informal Settlement. The data collection was carried out by final year tertiary level
student-teachers whose literacy and communication skills are good. The student
researchers were enlightened and enthusiastic members of the HIV-AIDs related
Students Against Aids (SAA) Club at RCE.

Further, the findings of this survey can help the planning of community based social
programs including education, health, water supply, town planning, giving of aid and
donations to needy people, recruitment of employees, as well as the allocation of town
plots. The findings of this study can, as well, be used elsewhere to inspire by people in
similar circumstances to improve the quality of lives in homes.

Summary of Findings
From the employed process of information gathering and analysis, homesteads in the
Kehemu settlement of Rundu town can be characterized as having the following
features:

1. Kehemu has a relative balance of young and mature residents.

2. There are many females and few males in Kehemu.
3. Need for food is a high priority in Kehemu homes, followed by shelter and the need
for health facilities, shoes, and sanitation and beddings.
4. There is no one particular source of income among Kehemu residents, however
some of their sources of income include: small scale businesses, piecework and
farming, and salaries and wages.
5. Homesteads are crowded, with 58% of the homes having 11 or more people.
6. Homestead occupants are long-term residents. 84% have lived there for seven or
more years.
7. Homestead compounds are frequently cleaned.
8. Residents of Kehemu are interested in learning new skills helpful to improving
their economic status.
9. Kehemu residents are economically poor and therefore handicapped in several
ways.
10. The Kehemu environment in generally clean but homes are characterized by
poverty, are unfenced, and lack essential amenities like water.

Analysis of Findings

2
1. The presence of all age groups in Kehemu suggests a potential demand for a whole
range and variety of social services for all age groups. Kehemu would need services for
babies, preschool children, school-going youths, and all generations of adults.
Kehemu would need churches, schools, hospitals, shops, and jobs for its residents.

2. Since women are in majority in Kehemu, it’s likely that for one reason or another,
fathers are absent and women struggle alone to care for people in homes. However,
the absence of males could also be accounted for by the culture of females attending to
domestic chores while males, traditionally, attend to outdoor duties like fishing and
herding cattle. More recently males tend to take up employment as security guards or
taxi drivers. Therefore programmes that specifically target the education, the needs,
the roles, and the empowerment of women would be of high priority, to perhaps turn
the many home-based females into strength for community empowerment. Men who
are a minority may perhaps require protection from becoming extinct.

3. Food relief and other forms of assistance-in-kind would be a necessary priority for
Kehemu. Assistance-in-kind would be aimed at solving problems related to food-
production, shelter construction, access to health services, shoes, sanitation and
beddings. Availing of food for all age groups and the support for feeding on a balanced
diet in an economically challenged environment seem to be essential for Kehemu.

4. Small miscellaneous income generating programs would be an empowerment

solution to the generally poor and female dominated community which seems to have
no one particular source of income. Hence the concept of poverty reduction through
the Basic Income Grants (BIG) would be a useful option for Kehemu.

5. Initiatives that urgently address the construction of spacious houses of good quality
for the crowded households could improve the quality of life in Kehemu homes.

6. Programs aimed at improving lives in Kehemu are likely to succeed because the
people in the community are long-term residents of the “informal” settlement.

7. The fact that Kehemu residents frequently clean their economically poor
homesteads suggests that they are determined to improve their living conditions.
A parallel scenario would be the case of a person without new clothes who
nevertheless keeps the old ones clean and well groomed.

8. A mixed variety of education and skills acquisition programs would be suitable for
Kehemu residents who are interested in learning new enabling skills. For example
programs would vary to cater for different age groups, literacy levels, lengths and
depths of training, and costs of training. The Namibia Community Skills Development
Foundation (COSDEC) could be a seed partner in Kehemu skills development.

9. Poverty as a general handicap in several ways, suggests that residents of Kehemu

can be manipulated in different ways. While women may easily be prone to sexual
exploitation, males are likely to be involved in petty crime.

10. Poverty characterized homes of Kehemu which are not fenced and lacking basic
amenities are likely insecure and a discouragement to the acquisition of wealth and
property. The homes may promote outward flight or emigration of its mobile
members like men to other places in search of better life.

3
Conclusions of the Findings
This survey was undertaken to profile the Kehemu homesteads with a view to
establishing their suitability for the Home Based Care of HiV-Aids affected people.
The collection of data was conducted by four students of RCE from a stratified sample
of 19 homes in the Kehemu settlement. From an analysis of the findings, a typical
homestead in the Kehemu informal settlement is characterized by the following
features.
a. The homes have people of all age groups whose needs span the full range of human
generations ranging from small babies to grand-parents.
b. Females are many and males are few in the homes.
c. Homesteads are in priority need of food, shelter, health facilities, sanitation, shoes
and beddings.
d. People derive income from a miscellaneous range of known and unknown sources.
e. Homesteads are crowded which affects the quality of life.
f. People of Kehemu have lived there for a long time and are therefore not temporary
residents.
g. Though poor and unfenced, Kehemu homesteads are frequently swept clean.
h. People in Kehemu are interested in learning new skills that can help improve their
lives towards economic self reliance.
i. People in Kehemu homes are economically disadvantaged and susceptible to
different forms of manipulation especially during the prevalent hard economic
times.
j. Homesteads of Kehemu are generally not well fenced and without basic amenities
like water.

Recommendations from the findings

The nature of a homestead determines the kind of Home Based Care that its members
can get. From the profile of Kehemu homesteads several recommendations could be
made towards the improved Home Based Care for persons affected by HIV-AIDS. The
following recommendations seem pertinent for the Kehemu informal area of Rundu
Town.

a) Home Based Care services for Kehemu should be comprehensively versatile to

inclusively care for the hospice needs of people of all age groups.
b) Care should give priority to females but not neglect a minority of males.
c) Material donations are needed to help Kehemu homes in the priority order of Food,
shelter, health facilities, sanitation, shoes, and beddings.
d) Assistance aimed at improving incomes among Kehemu residents should be
diversely open to a diversely open range of known and unknown options.
e) The design and construction of spacious houses and homesteads that conveniently
accommodate large families for improved quality of life are an urgent need for
decongesting Kehemu. The space management of the homesteads would help the
efficient use of homes by its many members.
f) Formalizing the residency of people in the Kehemu Informal Settlement would
help people to confidently plan and implement improvements to homesteads
where they have lived for long. The “informality” tag on the Kehemu confers a
squatter stigma that impedes the enthusiasm of developing the quality of homes.
g) Given the existing tradition of frequently sweeping their homes clean, all efforts
should not be spared in helping or strengthening them to further fence and make
improvements to their homesteads for better living. General public services like
paved, marked, and lighted roads, water, electricity, garbage collection, schools,
churches, health clinics, sports and recreation facilities, could be made available by
the government as a strategic national investment in the better life of the country’s

4
 human resource. Ambitious urban planning should be done for Kehemu to arrest
urban squalor before it escalates further.
h) Educational institutions near Kehemu could be assisted in designing and providing
varied community development training programs tailored to different specific
groups of the willing people in Kehemu homes.
i. The Ministry of Health could promote training in basic skills in hygiene
and home based nursing.
ii. COSDEC could provide training in tailoring, food catering, dress-making
and other areas of their expertise.
iii. RVTC could train people in the use of local materials in construction of
affordable improved shelters, and in skills like carpentry, metalwork, and
home management.
iv. RCE could construct a state of the art demonstration school and use it to
train village and community based teachers of preschool children and for all
other school levels especially for Kehemu.
v. Churches could be used to strengthen social educational sessions
targeting the elderly and other groups like orphans and vulnerable children.
vi. Various government ministries and independent donor agencies
could be lobbied to provide funding and expertise, and collaborate with local
institutions towards initiating and sustaining the Kehemu focused social
education programs for home improvement.
i) Since hunger has no pride, culture, education or dignity the poverty of residents of
Kehemu
should be addressed urgently before Home Based Care can be improved to redeem
the dignity of people affected by sickness. Poverty could be reduced so that people
may be less susceptible to diverse manipulations.
j) All homes in Kehemu should be helped with fencing and be supplied with basic
amenities like water and toilets which will directly impact on the health and quality
of lives of people living there. This will be a sure way of promoting home based
care in those homes.

Conclusion
This study has profiled the homestead environments of the Kehemu informal
settlement of Rundu town on which the nature of Home Based Care which patients
can receive depends. Although they are generally swept clean the homes are mostly
poor, crowded, and dominated by women who have lived there for a long time.
Incomes are low and accrued from a miscellaneous range of sources including paid
wages. The residents are interested in improving their lives if suitable social services
can be availed to them. The profiled environment provides some insights into the
challenges which the Home based caring of HIV-AIDS patients would have to be face
at Kehemu. There is hope that social institutions can direct ambitious development
plans towards the socio-economic up-liftment of life in Kehemu and thus the capacity
for improved caring of the community’s home-base patients.

Appendices
Appendix 1: QUESTIONAIRE USED
Available on request

Appendix 2: NAMES OF RESPONDENTS.

Available on request.